Antibiotic Choice for Children Hospitalized With Pneumonia and Adherence to National Guidelines
Derek J Williams1, Kathryn M Edwards2, Wesley H Self3
1Divisions of Hospital Medicine and Department of Pediatrics, Vanderbilt University School of Medicine, Vanderbilt Vaccine Research Program, Nashville, Tennessee; derek.williams@vanderbilt.edu.
Insights
National guidelines for childhood community-acquired pneumonia (CAP) led to decreased use of broad-spectrum antibiotics and increased use of narrow-spectrum ones like ampicillin. Hospital-based efforts enhanced guideline implementation and antibiotic prescribing changes.
Area of Science:
- Pediatric Infectious Diseases
- Antimicrobial Stewardship
- Public Health Guidelines
Background:
- National guidelines in 2011 recommended narrow-spectrum antibiotics for childhood community-acquired pneumonia (CAP).
- The study evaluated the impact of these guidelines on antibiotic prescribing practices in three children's hospitals.
Purpose of the Study:
- To assess the effect of national CAP management guidelines on antibiotic selection in hospitalized children.
- To determine if hospital-level implementation efforts influenced adherence to the guidelines.
Main Methods:
- A cohort of 2121 children with CAP was studied from January 2010 to June 2012.
- Antibiotic prescribing patterns (third-generation cephalosporins vs. penicillin/ampicillin) were analyzed pre- and post-guideline implementation.
- Segmented linear regression compared observed prescribing with projected use.
Main Results:
- Third-generation cephalosporin use decreased by 12.4% and penicillin/ampicillin use increased by 11.3% within 9 months post-guidelines.
- Significant changes in antibiotic prescribing were most evident in hospitals actively disseminating the guidelines.
- Initial use of third-generation cephalosporins was 52.8% versus 2.7% for penicillin/ampicillin pre-guidelines.
Conclusions:
- National guidelines for CAP successfully shifted antibiotic prescribing towards narrower-spectrum agents.
- Proactive dissemination of guidelines within hospitals correlated with more substantial changes in prescribing patterns.
- Targeted, hospital-based implementation strategies are crucial for effective guideline adoption.
Introduction:
The 2011 national guidelines for the management of childhood community-acquired pneumonia (CAP) recommended narrow-spectrum antibiotics (eg, ampicillin) for most children hospitalized with CAP. We assessed the impact of these guidelines on antibiotic prescribing at 3 children's hospitals.
Methods:
Children hospitalized with clinical and radiographic CAP were enrolled from January 1, 2010, through June 30, 2012, at 3 hospitals in Tennessee and Utah as part of the Centers for Disease Control and Prevention Etiology of Pneumonia in the Community study. Antibiotic selection was determined by the treating provider. The impact of the guidelines and hospital-level implementation efforts was determined by assessing the monthly percentage of enrolled children receiving third-generation cephalosporins or penicillin/ampicillin. Segmented linear regression was used to compare observed antibiotic selection in the postguideline period with expected antibiotic use projected from preguideline months.
Results:
Overall, 2121 children were included. During the preguideline period, 52.8% (interquartile range 47.8-56.6) of children with CAP received third-generation cephalosporins, whereas 2.7% (2.1, 7.0) received penicillin/ampicillin. By 9 months postguidelines, third-generation cephalosporin use declined (absolute difference -12.4% [95% confidence interval -19.8% to -5.1%]), whereas penicillin/ampicillin use increased (absolute difference 11.3% [4.3%-18.3%]). The most substantial changes were noted at those institutions that implemented guideline-related dissemination activities.
Conclusions:
After publication of national guidelines, third-generation cephalosporin use declined and penicillin/ampicillin use increased among children hospitalized with CAP. Changes were more apparent among those institutions that proactively disseminated the guidelines, suggesting that targeted, hospital-based efforts are important for timely implementation of guideline recommendations.
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